The journal of the Royal College of Physicians of Edinburgh
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Hyperkalaemia, an elevated extracellular fluid potassium concentration, is a common electrolyte disorder and is present in 1-10% of hospitalised patients. Elevated serum potassium concentrations are usually asymptomatic but may be associated with electrocardiogram (ECG) changes. Hyperkalaemia occasionally leads to life-threatening cardiac arrhythmias. ⋯ Nebulised β-2 adrenoceptor agonists can augment the effects of intravenous insulin and glucose pending more definitive management of the recurrent hyperkalaemia risk. Additional management steps include stopping further potassium intake and careful review of prescribed drugs that may be adversely affecting potassium homeostasis. Changes to prescribing systems and an agreed institutional protocol for management of hyperkalaemia can improve patient safety for this frequently encountered electrolyte disorder.
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Acute kidney injury (AKI) represents a medical emergency associated with poor clinical outcomes. The international guideline group Kidney Disease: Improving Global Outcomes (KDIGO) has defined AKI according to rises in serum creatinine and/or reductions in urine output. Any patient who meets the criteria for AKI should be reviewed to ascertain the cause of AKI and the severity of the injury should be staged. ⋯ The optimal choice of intravenous fluid therapy remains controversial. There is currently renewed interest in more specific therapies for AKI secondary to hypoperfusion and/or sepsis, which have been previously unsuccessful. A number of therapeutic strategies are presently being explored in clinical trials.
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J R Coll Physicians Edinb · Jan 2013
Are newly qualified doctors prepared to provide supportive and end-of-life care? A survey of Foundation Year 1 doctors and consultants.
To establish whether Foundation Year 1 (FY1) doctors in Edinburgh are sufficiently prepared to deliver generalist palliative care, with a view to informing developments in undergraduate and postgraduate medical education. ⋯ Newly qualified doctors were not adequately prepared to deliver generalist palliative care and lacked first-hand experience of end-of-life issues. Current reviews of palliative care education should address the learning and supportive needs of our most junior doctors more effectively.
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J R Coll Physicians Edinb · Jan 2013
Biography Historical ArticleJames Taylor (1859-1946): favourite disciple of Hughlings Jackson and William Gowers.
In neurological circles today the name James Taylor (1859-1946) is probably remembered mainly for his role in editing the Selected Writings of John Hughlings Jackson, the most readily available source of Jackson's contributions to neurological knowledge. Taylors' own neurological achievements are largely or entirely forgotten, but in his day he was an influential figure whose career linked the great figures of the golden era of late nineteenth century British neurology to the neurology of the first half of the twentieth century. Not only was he a junior professional colleague and close friend of both John Hughlings Jackson and William Gowers, he also produced a substantial corpus of neurological writings in his own right, including a textbook of child neurology and the first English language account of subacute combined degeneration of the spinal cord.